Dataset Information

Is direct access to obstetricians/gynecologists effective at improving maternal health behaviors?

ABSTRACT:

Objective

To examine the effects of state legislation mandating direct access to obstetricians and gynecologists (OB/GYNs) on maternal health behaviors and infant health outcomes.

Data sources

1992-2002 Natality Detail File; 1994-2002 Pregnancy Assessment and Monitoring Survey (PRAMS).

Study design

Using variation in state policy over time, we use individual-level data from two sources to consider the effects of direct access legislation on prenatal care utilization, maternal health behaviors during pregnancy, and infant health outcomes.

Principal findings

Our results suggest that there is little evidence that direct access laws are effective at improving prenatal care access or conferring benefits to mothers and infants. These results are consistent across two data sets, a variety of specifications, and specific subgroups of women who are most likely to be affected by direct access legislation.

Conclusion

We conclude that direct access to OB/GYNs is not related to improvements in maternal health behaviors or infant health outcomes. If policy makers are interested in reforms that improve maternal and infant health, we recommend a focus on alternative policies.

SUBMITTER: Durrance CP

PROVIDER: S-EPMC3165186 | biostudies-literature | 2011 Aug

REPOSITORIES: biostudies-literature

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Publications

Is direct access to obstetricians/gynecologists effective at improving maternal health behaviors?

Durrance Christine Piette CP Hankins Scott S

Health services research 20110330 4

<h4>Objective</h4>To examine the effects of state legislation mandating direct access to obstetricians and gynecologists (OB/GYNs) on maternal health behaviors and infant health outcomes.<h4>Data sources</h4>1992-2002 Natality Detail File; 1994-2002 Pregnancy Assessment and Monitoring Survey (PRAMS).<h4>Study design</h4>Using variation in state policy over time, we use individual-level data from two sources to consider the effects of direct access legislation on prenatal care utilization, matern ...[more]

PMID: 21449955

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Project description:The successful management of a childbirth emergency will be dependent on the decision-making of involved obstetricians and gynecologists. Individual differences in decision-making may be explained through personality traits. The objectives of the present study were (I) to describe personality trait levels of obstetricians and gynecologists and (II) to examine the relationship between obstetricians' and gynecologists' personality traits and decision-making styles (Individual, Team and Flow) in childbirth emergencies; also controlling for cognitive ability (ICAR-3), age, sex and years of clinical experience. Obstetricians and gynecologists, members of the Swedish Society for Obstetrics and Gynecology (N = 472) responded to an online questionnaire that included a simplified version of the Five Factor Model of personality (IPIP-NEO), and 15 questions concerning childbirth emergencies based on a model of decision-making styles (Individual, Team and Flow). The data was analyzed using Pearson's correlation analysis and multiple linear regression. Swedish obstetricians and gynecologists scored (P < 0.001) lower on Neuroticism (Cohen's d = - 1.09) and higher on Extraversion (d = 0.79), Agreeableness (d = 1.04) and Conscientiousness (d = 0.97) compared to the general population. The most important trait was Neuroticism, which correlated with the decision-making styles Individual (r = - 0.28) and Team (r = 0.15), while for example Openness only trivially correlated with Flow. Multiple linear regression showed that personality traits with covariates explained up to 18% of decision-making styles. Obstetricians and gynecologists have notably more distinct personality levels than the general population, and their personality traits relate to decision-making in childbirth emergencies. The assessment of medical errors in childbirth emergencies and prevention through individualized training should take account of these findings.

Project description:BackgroundPublic insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care.MethodsThis community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders.DiscussionThe information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities.Trial registrationThis protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404 . Registered June 6, 2018.

Dataset Information

Is direct access to obstetricians/gynecologists effective at improving maternal health behaviors?

Objective

Data sources

Study design

Principal findings

Conclusion

Publications

Is direct access to obstetricians/gynecologists effective at improving maternal health behaviors?

Similar Datasets

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